AUTHOR=Cheng Wei , Ma Xu-Dong , Su Long-Xiang , Long Yun , Liu Da-Wei , Du Bin , Qiu Hai-Bo , Guan Xiang-Dong , Chen De-Chang , Kang Yan , Tong Zhao-Hui , Peng Zhi-Yong , Shang You , Zheng Rui-Qiang , Li Shu-Sheng , Pan Chun , Huang Xiao-Bo , Zhan Qing-Yuan , Ding Ren-Yu , Huang Chao-Lin , Yin Yong-Jie , Li Sheng-Qing , Li Xu-Yan , Jiang Li , Hu Ming , Li Xin , Zhou Xiang , Jing Zhi-Cheng , Guo Yan-Hong , Zhang Shu-Yang 

TITLE=Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.659793

DOI=10.3389/fmed.2021.659793

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic.</p><p><bold>Methods:</bold> Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China.</p><p><bold>Results:</bold> Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, <italic>P</italic> = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, <italic>P</italic> = 0.24). As for the ECMO patients, the median age was 58 (47–66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, <italic>P</italic> = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, <italic>P</italic> = 0.022), and better CO<sub>2</sub> removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, <italic>P</italic> = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, <italic>P</italic> = 0.018; 49 vs. 29 days, <italic>P</italic> = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74).</p><p><bold>Conclusions:</bold> ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.</p>